News & Analysis as of

Value-Based Purchasing

CMS Issues FY 2019 SNF Proposed Rule

by King & Spalding on

On April 27, 2018, CMS issued a proposed rule that would update the payments rates under the prospective payments system (PPS) for skilled nursing facilities (SNFs). Additionally, the proposed rule includes proposals for the...more

CMS Releases FY 2019 Proposed Payment Rules

by Baker Ober Health Law on

On April 24 and 27, 2018, CMS launched its annual gaggle of proposed regulations – each with the theme of "Patients over Paperwork" – with the stated goal of "advanc[ing] the agency's priority of creating a patient-driven...more

OIG Gainsharing Opinion Facilitates P4P

by Tucker Arensberg, P.C. on

Although it has been almost a decade since the OIG has issued a gainsharing opinion, OIG Advisory Opinion No. 17-09 confirms the federal government’s support of the pay for performance concept. OIG 17-09 is the first...more

Manatt on Medicaid: 10 Trends to Watch in 2018

Medicaid has entered a period of volatile change, unprecedented in its 51-year history. With 74 million members nationwide,1 Medicaid provides health coverage to more than one in four Americans, ensuring access to...more

Home Health Payment Rule Published

by Baker Ober Health Law on

On November 1, 2017, CMS released the Final Rule for the 2018 home health prospective payment system rate update, including the CY 2019 case mix adjustment methodology refinements. CMS also made changes to the Value Based...more

Impact of Value-Based Health Care on the Medical Device Industry: Three Takeaways From the Case for Transformation

by Ropes & Gray LLP on

Introduction: The Case for Transformation - In the world of fee-for-service health care, most medical devices were sold to hospitals or other health care providers for use in the diagnosis or treatment of patients. Except...more

CMS Issues IPPS and LTCH PPS Final Rule for FY 2018

by King & Spalding on

On August 2, 2017, CMS issued the Fiscal Year (FY) 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System Final Rule (Final Rule) that updates...more

GAO Releases Report on Evaluation Methodology in Hospital Value-Based Purchasing Program

by King & Spalding on

On June 30, 2017, the Government Accountability Office (GAO) released a report on the Hospital Value-Based Purchasing (HVBP) program, which evaluates hospital performance on quality and efficiency measures, and provides...more

Measures of success: How value-based pricing may change the pharmaceutical industry

by Hogan Lovells on

Adoption of value-based pricing, where drug prices are linked to real-world outcomes rather than on a per-pill or per-treatment basis, will have a profound impact on the pharmaceutical industry. And with the Centers for...more

Measures of success: How value-based pricing may change the pharmaceutical industry

by Hogan Lovells on

Hogan Lovells partner Alice Valder Curran teams up with Robert Spurr of Novartis to outline the challenges and share potential solutions to consider when entering into value-based pricing arrangements. Adoption of...more

CMS Releases FY 2018 Hospital Inpatient Prospective Payment System Proposed Rule and Request for Information

by King & Spalding on

On April 14, 2017, CMS issued the annual Hospital Inpatient Prospective Payment System (IPPS) Rule for FY 2018 (the “Proposed Rule”) which will affect discharges on or after October 1, 2017. CMS estimates that IPPS operating...more

Healthcare Law Update: March 2017

by Holland & Knight LLP on

Enforcement - OIG Issues Advisory Opinion Allowing Free or Reduced-Cost Lodging and Meals - On March 3, 2017, the U.S. Department of Health and Human Services' (HHS) Office of Inspector General (OIG) issued...more

Want to run the government like a business? Bring back the ACA.

by Snell & Wilmer on

Just days after his inauguration, President Donald Trump signed an executive order to delay further implementation of the Patient Protection and Affordable Care Act (ACA). This is just one of many steps the President and...more

10 Things You Need to Know About Health Care Bankruptcies in 2017

by Foley & Lardner LLP on

The coming year will likely continue to be a tumultuous year for health care providers, suppliers, and payers, as they adapt to meet new challenges and market forces, particularly in light of the open questions as to the...more

CMS Releases the 2016 OPPS Final Rule

by Baker Ober Health Law on

On November 1, 2016, CMS published its final policy changes, quality provisions, and payment rates for 2017, as they relate to the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center...more

Home Health Agency PPS Update for 2017: Quality, Quality, Quality

by Baker Ober Health Law on

On November 3rd, CMS published the Final Prospective Payment System (PPS) Rule for Home Health Agencies (HHAs) for CY 2017 at 81 FR 76702 (Nov. 3, 2016). The rule implements annual changes to the PPS rate for HHAs and...more

CMS Releases OPPS and ASC Payment Final Rules, Finalizes Changes to Off-Campus Provider-Based Status

by King & Spalding on

On November 1, 2016, CMS released the final payment rates and policy changes in the Hospital Outpatient Prospective Payment System (OPPS) final rule (OPPS Final Rule) and Ambulatory Surgical Center Payment System Final Rule...more

SNF and IRF Proposed Changes for FY 2017

by Baker Ober Health Law on

On August 5th, CMS published final rules updating the Medicare payment rates for skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) for FY 2017. The rules, both of which go into effect on October...more

Does Digital Health Need Reimbursement?

by McDermott Will & Emery on

One of the most talked about topics when it comes to digital health is the reimbursement under various third-party payer programs. Most notably, telemedicine and remote monitoring have received a lot of attention, and the...more

CMS Releases FY 2017 Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Final...

by King & Spalding on

On August 2, 2016, CMS released a final rule (Final Rule) with updates to the Hospital Inpatient Prospective Payment System (Hospital IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) affecting...more

CMS Proposes CY 2017 Home Health PPS Rate, Updates to ValueBased Purchasing Model and Quality Reporting

by McDermott Will & Emery on

The US Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) released proposed updates to its Calendar Year (CY) 2017 Home Health Prospective Payment System (HH PPS) in the July 5, 2016,...more

CMS Releases the 2016 OPPS Proposed Rule

by Baker Ober Health Law on

On July 15, CMS published its proposed policy changes, quality provisions, and payment rates for 2017 as they relate to the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC)...more

Manatt on Health Reform: Weekly Highlights - July 2016 #3

Massachusetts’s Marketplace eliminates cost-sharing for addiction treatment in subsidized QHPs; Montana cuts its uninsurance rate in half; and a Kaiser report identifies the 50 most costly drugs for Medicaid....more

CMS Releases Calendar Year 2017 OPPS Proposed Rule

by King & Spalding on

On July 6, 2016, CMS released the Calendar Year (CY) 2017 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule. In addition to significant proposals...more

Additional Opioid Policy Changes Announced: What You Need to Know

by Foley & Lardner LLP on

Despite the July 4 holiday, the past week featured significant regulatory and legislative action addressing the use of opioids and pain management. The changes are in keeping with the Government-wide push to better understand...more

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